Bedside Sonography for Detection of Postprocedure Pneumothorax

Abstract

Background Bedside ultrasonography in the diagnosis of pneumothorax has been well described in emergency and trauma medicine literature. Its role in detection of iatrogenic pneumothoraces has not been studied. We describe the performance of bedside ultrasonography in detection of procedure related pneumothoraces and highlight some limitations. Methods 185 patients underwent thoracentesis (n=60), transbronchial biopsy (n=48), CT-guided lung biopsy (n=76), and CT-guided cryoablation of a lung mass (n=1). Bedside transthoracic ultrasound examination and post-procedure chest radiograph were performed in all patients. Patients in whom pleural surface was not well imaged with ultrasound were said to have a limited exam. Chest x-ray was the standard for diagnosing pneumothorax. Results Chest x-ray detected pneumothorax in 8/185 patients (4.0%). Ultrasound diagnosed pneumothorax in seven of these patients. Sensitivity, specificity and diagnostic accuracy were 88%, 97% and 97%, respectively. Limited quality ultrasound examinations due to pre-existing lung disease was seen in 43/185 patients. The positive and negative likelihood ratios for patients with adequate scans were 55 and 0.17, respectively. Likelihood ratio for patients with limited quality scan was 1.08. Conclusions Bedside chest ultrasonography, in the presence of good quality scan, is a valuable tool in the evaluation of post procedure pneumothorax. Patients with preexisting lung disease in whom the quality of ultrasound examination is limited should be studied with a chest x-ray.

The Role of Ultrasound and Air Leak Measurement in Assessing Lung Expansion after Thoracic Surgery

“…Our results were also comparable to those found by Shostak E. et al [7] in a similar study but with minor procedures. They performed transthoracic ultrasound in a series of 185 patients submitted to thoracentesis, transbronchial biopsy and computed tomography-guided needle lung biopsy.…”

“…However there is not such a consensus regarding ultrasound benefits in thoracic surgery patients. Different studies have been published proving bedside ultrasound is a valuable tool in the management of these patients [7] [10]- [16], meanwhile other authors have warned about the limitations of the technique [8] [17]- [20].…”

Avoiding Routine Chest Radiography after Transbronchial Biopsy Is Safe

“…It is important, however, to mention that the high accuracy of ultrasonography has been evaluated predominantly among acute trauma patients [15] and not in a population of patients with underlying lung pathologies undergoing procedures with a potential for iatrogenic pneumothorax. Indeed, in the largest study which specifically examined this issue [16], it was shown that as much as a quarter of the studies were of limited quality due to lung and pleural pathologies, necessitating the use of chest X-ray. Furthermore, as of today, ultrasound technology and the knowledge required to utilize it is still not routinely available in all the centers performing bronchoscopy worldwide.…”

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

“…Literature: Guideline adaptation BTS 2010: Shostak et al [79], Sartori et al [74] de Novo Research: Garofalo et al [252], Kreuter et al [225], Kumar et al [226], Reissig and Kroegel [227] Consensus rate: 100%…”